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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The adult population impact of HIV care and antiretroviral therapy in a resource poor setting, 2003-2008
AIDS, Volume 26, No. 12, Year 2012
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Description
Objective: To describe the population uptake of HIV care including antiretroviral therapy (ART) and its impact on adult mortality in a rural area of western Kenya with high HIV prevalence during a period of rapid HIV services scale-up. Design: Adult medical chart data were abstracted at health facilities providing HIV care/ART to residents of a Health and Demographic Surveillance System (HDSS) and linked with HDSS demographic and mortality data. Methods: We evaluated secular trends in patient characteristics across enrollment years and estimated proportions of HIV-positive adult residents receiving care. We evaluated adult (18-64 years) population mortality trends using verbal autopsy findings. Results: From 2003 to 2008, 5421 HDSS-resident adults enrolled in HIV care; 61.4% (n=3331) were linked to HDSS follow-up data. As the number of facilities expanded from 1 (2003) to 17 (2008), receipt of HIV services by HIV-positive residents increased from less than 1 to 29.5%, and ART coverage reached 64.0% of adults with CD4+ cell count less than 250cells/μl. The proportion of patients with WHO stage 4 at enrollment decreased from 20.4 to 1.9%, and CD4+ cell count testing at enrollment increased from 1.0 to 53.4%. Population-level mortality rates for adults declined 34% for all causes, 26% for AIDS/tuberculosis, and 47% for other infectious diseases; noninfectious disease mortality rates remained constant. Conclusion: The initial years of rapid HIV service expansion coincided with a drop in adult mortality by a third. Continued expansion of population access to HIV clinical services, including ART, and program quality improvements will be necessary to achieve further progress in reducing HIV-related morbidity and mortality. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Gargano, Julia W.
United States, Atlanta
Centers for Disease Control and Prevention
United States, Atlanta
National Center for Emerging and Zoonotic Infectious Diseases
Laserson, Kayla F.
Kenya, Nairobi
Kenya Medical Research Institute
Muttai, Hellen C.
United States, Atlanta
Centers for Disease Control and Prevention
Odhiambo, Frank Akoth
Kenya, Nairobi
Kenya Medical Research Institute
Orimba, Vincent
Kenya, Nairobi
Kenya Medical Research Institute
Adamu-Zeh, Mirabelle
Kenya, Nairobi
Kenya Medical Research Institute
Williamson, John Michael
United States, Atlanta
Centers for Disease Control and Prevention
Sewe, Maquins Odhiambo
Kenya, Nairobi
Kenya Medical Research Institute
Nyabiage, Lennah
Kenya, Nairobi
Ministry of Health Nairobi
Owuor, Karen
Kenya, Nairobi
Kenya Medical Research Institute
Broz, Dita
United States, Atlanta
Centers for Disease Control and Prevention
Marston, Barbara J.
United States, Atlanta
Centers for Disease Control and Prevention
Ackers, Marta Louise
United States, Atlanta
Centers for Disease Control and Prevention
Statistics
Citations: 45
Authors: 13
Affiliations: 4
Identifiers
Doi:
10.1097/QAD.0b013e328353b7b9
e-ISSN:
14735571
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya